Hummelen J W
Tijdschr Psychiatr. 2009;51(6):379-86.
This article considers whether failure to include a patient's subjective experiences in a psychiatric assessment can result in an inadequate diagnosis of psychotic symptoms. A psychodynamic approach gives specific attention to a patient's subjective experiences.
To investigate whether a psychodynamic assessment of psychotic symptoms based on the structural interview devised by Kernberg can be useful in clinical practice.
First of all, the psychodynamic assessment of reality testing is described. This is followed by an investigation of the extent to which this method is compatible with the findings of the cognitive model for psychoses. Then some interrater-reliability studies are discussed.
Within the psychodynamic interview the focus on inducing anxiety and on withholding contextual information from the patient is compatible with the cognitive model for psychoses. Reliability studies should be confined to delusions and hallucinations.
Psychodynamic assessment can be a useful addition to the standard psychiatric assessment of psychotic symptoms. However, further studies of the reliability of the psychodynamic assessment are required.
本文探讨在精神病评估中未纳入患者主观体验是否会导致对精神病症状的诊断不足。心理动力学方法特别关注患者的主观体验。
研究基于克恩伯格设计的结构化访谈对精神病症状进行心理动力学评估在临床实践中是否有用。
首先，描述对现实检验的心理动力学评估。接着考察该方法与精神病认知模型研究结果的契合程度。然后讨论一些评分者间信度研究。
在心理动力学访谈中，关注引发焦虑以及向患者隐瞒背景信息与精神病认知模型相符。信度研究应限于妄想和幻觉。
心理动力学评估可作为对精神病症状标准精神科评估的有益补充。然而，需要对心理动力学评估的信度进行进一步研究。
